| Doctor Name: | JESSICA K SELF |
| NPI Number: | 1417324310 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | 1-126416 |
| Business Practice Address: | 70 Plaza Dr Pell City, AL - 351259314 |
| Business Phone Number: | 2058149284 |
| Business Fax Number: | 2058149626 |
| Mailing Address: | 70 Plaza Dr, PELL CITY |
| State: | AL |
| Postal Code: | 351259314 |
| Phone Number: | 2058149284 |
| Fax Number: | 2058149626 |
| NPI Enumeration Date: | 08/26/2015 |
| NPI Last Update Date: | 08/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1-126416 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |